Just as there are advantages of cord blood banking, so are there disadvantages. However, the benefits of cord blood stem cell transplants far outweigh the disadvantages. In order for the transplants done using cord blood cells to be successful, remarkable signs of engraftment should occur. When we talk of engraftment, it simply refers to the opposite of rejection.
Engraftment is an indication that the stem cell transplant is working on the individual or the cells have accepted those of the patient. Two measurable signs that indicate an engraftment include:
- Recovery of neutrophil- this is a kind of white blood cell
- Recovery of platelet production – this is the clotting factor
When these clinical signs are evident in cord blood stem cell transplantation, it indicates that the procedure is working on the patient. Usually, in cord blood cell transplants, the two indicatives take longer to recover when compared to cases of bone marrow cell transplants. What this means is that the lab values for platelet production and white blood cell production tend to take longer to elevate following cord blood stem cells transplantations than it is seen in transplants involving use of bone marrow stem cells.
An aspect that influences engraftment time is what is known as cell dose. This refers to concentration or amount of useful cells that are within the blood sample and it is directly related to the cord blood volume. In cord blood, the volume of stem cells is limited, and this means the amount of stem cells found in cord blood is about 10 percent less compared to that found in samples of bone marrow. One unit of cord blood contains about 50 to 200ml of blood. So, if a unit has less than this amount, it is often discarded because it is considered to be unsatisfactory. The cell dose isn’t high enough.
About 50 percent or more samples of umbilical cord collection tend to have an unsatisfactory cell dose or volume. Generally speaking, cord blood transplants require fewer stem cells, so a volume ranging from 50 to 100 ml of umbilical cord blood is able to provide sufficient cell dose for a baby or a young adult. That being said, if the recipient requires additional cells, it would not be possible to get them from the newborn since the blood volume is considered to be of a limited amount.
For a newborn to need his or her own cord blood sometimes later is life, something called an autologous transplant, there is usually a limited chance. A majority of commercial cord blood banking facilities will advocate that parents bank the infant’s cord blood in what they call a biologic insurance. What parents should however know is that the probably of a child using his or her own umbilical cord blood tends to be extremely small over the infant’s lifetime.
It is estimated that a child can use his or her cord blood only 1 time out of 400 times to 1 time out of 200,000 times. This makes it very rare for the child to use it. There are also instances where using own cord blood isn’t advisable, for example, in treating disorders that are of genetic origin, for example treating malignant cancers like leukemia. This is because the mutations of the cancer cells are within the DNA of the umbilical cord. If the cord blood of the child was to be used to treat leukemia, it would contaminate the baby with that same disease.
Today, it is not known, how the collected and preserved cord blood can remain useful in its frozen state. Some research indicate that it can stay up to 15 years, however, it is not exactly known how long the cells would last over the individual’s lifetime. Maintaining the blood over time presents a big financial cost if it is being stored in private banks. It is not cost effective for parents to consider storing their infant’s cord blood for own use (referring to use by the infant) because the probability that it could be used is just too small.
The quality of the blood specimen that is available for transplant may not be guaranteed because of lack of proper regulation of cord blood banks.
To sum up on the disadvantages of cord blood, we would say that:
- It has limited cell dose, and additional cell doses aren’t available
- There is slow engraftment
- Limited benefit because of hereditary disorders where autologous donation is to be applied
- Issues with storage for example; quality control, cost associated with extended storage time, and unknown viability of the cord blood in the long run.
Keywords: umbilical cord blood; stem cells; cord blood stem cells; cord blood banking; cord blood cells; commercial cord blood banking; cord blood banks
- Umbilical Cord Blood: Information for Childbirth Educators. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3209739/
- Advantages And Disadvantages: Cord Blood Banking. Available at https://medium.com/@rkrish/advantages-and-disadvantages-cord-blood-banking-a00bbe876cec
- Disadvantages of Cord Blood Banking. Available at http://www.epigee.org/disadvantages-with-cord-blood-banking.html
- Collection and Preservation of Cord Blood for Personal Use. Available at https://www.sciencedirect.com/science/article/pii/S1083879107005745